Health Care Agency Must Do a Better Job at Orangewood

The Orange County Juvenile Justice Commission has done a good job in exposing major flaws in the system for administering mental health services to children held in custody. In the process, the commission presented compelling evidence why government claims of confidentiality should be considered with skepticism.

This month the commission issued the executive summary of its inquiry into the handling of needs of youth at Orangewood, the county’s shelter for neglected and abused youngsters, and at Juvenile Hall, the facility for those in trouble with the law. The report varied sharply with the claims by the county two years ago that all was fine at Orangewood.

The first allegations of improper medication of children at Orangewood were leveled three years ago by people who worked there. Three medical professionals looked into the claims and issued a report whose conclusion reportedly was that things weren’t bad at all.

But the county refused to release the audit. The county’s lawyers claimed that the doctors had been promised confidentiality, which allowed them to present their findings more freely. At the time, a former mental health supervisor at Orangewood said she wanted to know how the auditors reached their conclusions. “If they had nothing to hide, they would release everything,” she said. It turns out she was right.

Even when one arm of the county government, the Juvenile Justice Commission, tried to obtain the audit, lawyers for another arm of the county, the Health Care Agency, resisted, insisting it was confidential. Fortunately, the commission prevailed.

Contrary to the rosy picture supposedly presented by the auditors, the commission found that Orangewood psychiatrists failed to keep accurate records of what drugs were being prescribed and in what doses. The commission also found that after it started investigating, some doctors apparently rewrote medical charts and created new files to make it appear that all was in order.

Those actions would be terrible in any situation. Not charting drugs runs the risk of producing a combination of medications that should not be prescribed. The alleged omissions are especially shocking when conducted at a home designed to shelter traumatized, vulnerable children yanked away from their families and cast in bewilderment into alien circumstances. No wonder the county was reluctant to make the audit public.

The county’s Health Care Agency is responsible for medical care at Orangewood, which is operated by the county’s Social Services Agency. The Juvenile Justice Commission report said all three Orangewood staffers or former employees it interviewed believed children at the home were subjected to research by county doctors. All nine Health Care Agency workers interviewed denied research was done.

This topic cries out for further inquiry. The commission was properly candid in admitting that some of its questions were unanswered. Where that occurred, it is up to the county supervisors to demand the answers. Board of Supervisors Chairman William G. Steiner, the former director of Orangewood, would be the natural choice to keep insisting on more information, and he deserves support from his colleagues on the board.

The Juvenile Justice Commission said there had been some improvement in the situation since it began its investigation more than two years ago. But it also outlined numerous areas in which more improvement is needed.

One disquieting note in the report was the assertion that 13 recommendations made by the grand jury that looked into mental health services five years ago do not appear to have been implemented. The grand jury report should not have been consigned to the “file and forget” pile. The new report from the Juvenile Justice Commission most certainly does not deserve that fate either.

The Health Care Agency has to do a better job at Orangewood. The county’s lawyers have to look for ways to make documents public, not hide them. The county’s taxpayers have a stake in knowing that the shelter is being run properly, and the children deserve the best possible care. Covering up information is bad policy and is wrong.